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Anxiety among Cancer Patients

Posted 10/8/2014

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  I suspect that it is impossible to hear a cancer diagnosis and not experience some degree of anxiety. A mixture of anxiety and depression inevitably accompany at least the early days of cancer, and may intensify at critical junctures along the way. In my experience, the most difficult moments are diagnosis (including the staging work-up and whatever else must happen before a treatment plan is established), the start of active treatment, losing one's hair, the completion of active treatment, and, if relevant, the period around a recurrence and any later progression.

  Over the years, I have learned that the person I meet shortly after diagnosis may have very little to do with the psychological baseline of that same person at any other time. I can't tell you how many times a new patient has been referred to me with something like this: "Ms. R is so anxious that I can barely have a conversation with her. I don't know how she is going to manage treatment." When I first sit with Ms. R, I may well experience that same kind of intense anxiety, but I am usually able to help lower it with reassurance, information, and the promise that she will feel a bit better as time goes on. The point here, however, is that when I sit with Ms. R even a few weeks later, and most surely some months later, she is very likely to be composed, thoughtful, and articulate about the distress of those early days.

  Of course some people have continuing anxiety that may be bad enough to interfere with their functioning. This kind of excessive anxiety and worry that occurs daily and is associated with restlessness or fatigue or difficulty concentrating or irritability or troubles with sleep and appetite can be treated and relieved. Some people know that they have been anxious their whole lives, and a cancer diagnosis surely won't help. Others feel that the anxiety is associated with the diagnosis and is quite focused on those worries. If you fall into either group and are having trouble getting through the day without undue upset, please speak up. There are medications that may help, and almost certainly talking with a therapist will help a lot. There is absolutely no shame or failure of will here; the mistake would only be in trying to soldier through these feelings without enlisting the support and assistance that will make life much easier.

  This is an introduction to an article from ASCO about a study that has just appeared in the Journal of Clinical Oncology about this issue:

One in Three People with Cancer Has Anxiety or Other Mental Health Challenges

Results of a large study performed across cancer centers in Germany are being published online October 6, 2014 in the Journal of Clinical Oncology and show that 32% of people with cancer experienced some form of clinically relevant mental health challenge, such as anxiety, depressive and adjustment disorders. This prevalence is higher than in the general population, primarily due to a higher rate of anxiety and adjustment disorders.
Researchers in Germany report that nearly a third of more than 2,100 patients with cancer interviewed at inpatient and outpatient care centers experienced a clinically meaningful level of mental or emotional distress that meets the strict diagnostic criteria for mental disorders including anxiety, depressive and
adjustment disorders during the prior four weeks. The prevalence of these issues varied by cancer type. The highest prevalence was found among patients with breast cancer (42%) and head and neck cancer (41%), followed by malignant melanoma (39%). The lowest prevalence was seen among patients with
prostate cancer (22%), stomach cancers (21%), and pancreatic cancer (20%). The study — the largest to date assessing the mental and emotional health of patients with cancer using a fully standardized, diagnostic face-to-face interview — is published in the October 6 issue of the Journal of Clinical Oncology.
"These findings reinforce that, as doctors, we need to be very aware of signs and symptoms of mental and emotional distress. We must encourage patients to seek evaluation, support, and treatment if necessary as there are long-term risks often associated with more severe, untreated mental health disorders.
This research also sheds light on which patients we should watch more closely," said lead study author Anja Mehnert, PhD, a professor of psychosocial oncology at the University of Leipzig in Germany. "We also want to reassure patients who are struggling that they are not alone or unique, and that these
mental and emotional challenges can be temporary, especially with effective psychological support or state-of-the-art mental health treatment."


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